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PubMed2005

Massive cystic lymphangiomas of a fetus.

We present a fetus with progressive massive subcutaneous lymphangiomas leading to intrauterine death. A 28-year-old woman was referred to our hospital because of a precordial cystic mass of the fetus. An ultrasound revealed lymphangiomas extending from bilateral axillae to the anterior chest wall. At 18 weeks' gestation, amniocentesis was performed and the karyotype of the fetus was found to be normal 46, XY. Thereafter the lesions increased in size gradually and spread over the body. Amniotic fluid decreased, pericardial, and pleural effusion appeared, and cardiomegaly became evident. The fetus died in utero at 25 weeks' gestation. Postmortem examination revealed a male fetus surrounded with multicystic soft masses spreading over the body, and syndactyly (left third and fourth fingers) was present. Histologically, a number of irregularly dilated lymphatics extended through subcutaneous tissues to the skeletal muscles. No communications between the cysts and the thoracic or abdominal cavity existed, and no lymphatic dilations in the viscera were confirmed. As far as we know, such conditions have rarely been reported. Considering that in previous literature, a favorable prognosis of a fetus with an atypically located (lateral cervical or non-cervical) lymphangioma with a normal karyotype has been reported, our case may be included in a distinct pathological entity. When we find a lymphangioma in a fetus, careful follow-up by ultrasound is mandatory.

Adult↗
PubMed1998

Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study.

OBJECTIVE: To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses. DESIGN: Population based cohort study. SUBJECTS: 1 026 249 pregnancies without congenital malformations. SETTING: Sweden 1983-92. MAIN OUTCOME MEASURE: Late fetal death rate. RESULTS: Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women >=175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers. CONCLUSIONS: Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants-for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension.

Adolescent↗
PubMed1999

Pattern of pulmonary venous blood flow in the hypoplastic left heart syndrome in the fetus.

OBJECTIVE: To determine whether restriction at the atrial septum in the newborn with hypoplastic left heart syndrome can be predicted accurately by examining the pattern of pulmonary venous flow in the fetus. A restrictive atrial septum can contribute to haemodynamic instability before surgery for this lesion and has been associated with an increased mortality. DESIGN: Pulmonary venous pulsed Doppler tracings were compared between fetuses with hypoplastic left heart syndrome and controls. The size of the atrial septal defect on the postnatal echocardiogram was graded according to the degree of restriction. Pulsed Doppler tracings of pulmonary venous blood flow were obtained in 18 fetuses with left atrial outflow atresia and compared with 77 controls, adjusted for gestational age. Postnatal echocardiograms were available for analysis in 13 of 18 neonates. SETTING: A tertiary referral centre for fetal cardiology and paediatric cardiac surgery. RESULTS: Fetuses with hypoplastic left heart syndrome were different from controls in all pulmonary vein indices measured. As assessed from the postnatal echocardiogram, there were seven fetuses with a restrictive atrial septum. In these fetuses, the systolic flow velocity (p < 0.01), S/D ratio (p < 0.01), and peak reversal wave (p < 0.001) in the pulmonary vein tracing showed a good correlation with the degree of restriction. CONCLUSIONS: The Doppler pattern of pulmonary venous flow in the fetus with hypoplastic left heart syndrome appears to be a reliable predictor of restriction of the atrial septum in the neonate. This may help in the immediate post-delivery management of these infants before surgery.

Analysis of Variance↗
PubMed1994

Identification of second-trimester fetuses with autosomal trisomy by use of a sonographic scoring index.

PURPOSE: To evaluate the ability to identify fetuses with autosomal trisomy by use of sonographic features in the form of a scoring system. MATERIALS AND METHODS: The presence of nuchal thickening, long-bone shortness, pyelectasis, hyperechoic bowel, choroid plexus cyst, and major anatomic defects was prospectively evaluated in 60 trisomic fetuses aged 14-21 weeks and 106 second-trimester control fetuses. RESULTS: Forty-five fetuses had Down syndrome, 13 had trisomy 18, and two had trisomy 13. Based on previous criteria for short femur and humerus, pyelectasis, nuchal thickening, echogenic bowel, and choroid plexus cysts, a scoring system for detection of aneuploidy was developed. It enabled identification of 33 fetuses with Down syndrome (73%), 11 (85%) with trisomy 18, two (100%) with trisomy 13, and four control fetuses with abnormality (4%). The positive predictive value in patients in 1/250, 1/500, and 1/1,000 risk groups was 7.2%, 3.7%, and 1.9% for identification of a fetus with Down syndrome. CONCLUSION: These sonographic markers seem to be sensitive for the detection of chromosomal abnormalities.

Chromosomes, Human, Pair 13↗
PubMed1997

Third ventricle: size and appearance in normal fetuses through gestation.

PURPOSE: To define the size and appearance of the normal fetal third ventricle. MATERIALS AND METHODS: The third ventricle was prospectively assessed in 441 consecutive normal second- and third-trimester fetuses. The fetuses were divided into six gestational age ranges. Data regarding the size and configuration of the third ventricle were analyzed for each group. RESULTS: The third ventricle was seen in 435 of 440 (98.9%) fetuses. It appeared as a single echogenic line between the thalami in 171 (38.9%) fetuses, as parallel echogenic lines outlining a fluid-filled lumen in 243 (55.2%) fetuses, and as divergent lines delineating a V-shaped fluid-filled structure in 21 (4.8%) fetuses. The single-line configuration was most common early in the second trimester. Later in pregnancy, the ventricle walls could be discerned as separate parallel or divergent lines outlining a fluid-filled lumen. The average width of the ventricle was relatively constant at approximately 1 mm from 12 to 28 weeks. After this time, it enlarged, reaching a maximum 1.9 mm. CONCLUSION: The third ventricle can be imaged in most second- and third-trimester fetuses. Its size and configuration evolve through the second and third trimesters. This evolution must be considered in the evaluation of normality. At any gestational age, a third ventricle greater than 3.5 mm in width should be viewed with concern for abnormality.

Abnormalities, Multiple↗
PubMedDate not supplied

Comparison of unstimulated and stimulated behaviour in human fetuses with congenital abnormalities.

Unstimulated (passive) and stimulated behaviour [fetal heart rate (FHR) and movements (FA)] was studied in 32 normal fetuses and 10 fetuses with congenital abnormalities (CA). FHR and FA were recorded using a single 1.5-MHz ultrasound transducer and analysed by computer. A 5-second vibroacoustic stimulus (VAS) ('electronic artificial larynx') was used for the stimulation studies. Thus, passive and stimulated behaviour could be studied in a group of fetuses with known pathologies. One hour was used as the recording time for the passive studies and 20 min for the stimulation studies (10 min pre- and 10 min post-VAS). All CA fetuses had abnormalities of FHR and/or FA on recording passive behaviour compared to normal fetuses. However, 4 of the 10 fetuses with CA had responses to VAS that were within the normal range for both FHR and FA. We do not feel that computerised assessment of stimulated behaviour in fetuses with CA confers any advantage over analysis of passive behaviour.

Adult↗
PubMed2003

Intrapartum surveillance of IUGR fetuses with cardiotocography and fetal pulse oximetry.

OBJECTIVE: To investigate the efficacy and safety of intrapartum fetal pulse oximetry, as a predictor of metabolic acidosis at birth of fetuses with intrauterine growth retardation (IUGR). STUDY DESIGN: We studied 18 IUGR fetuses (group I) and a control group of 30 appropriate for gestational age (AGA) fetuses (group II) during labor. Both groups had abnormal fetal heart rate tracings and were monitored simultaneously throughout labor with cardiotocography and fetal pulse oximetry. Apgar scores, pH and base excess of fetal blood obtained from the umbilical artery after delivery were compared in both groups. SETTING: The Fetal Surveillance Unit of the 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, Athens University. RESULTS: In IUGR fetuses, when their oxygen saturation value (FSPO2) was less than 34%, cord artery pH was 7.10 +/- 0.04, base excess -13 +/- -1 mmol/l and Apgar scores < or =5 at the 5th min, and when FSPO2 was over 35%, artery pH was 7.29 +/- 0.08, base excess -8 +/- -2 mmol/l and Apgar scores > or =7 at the 5th minute. In cases of drops of FSPO2)below 30% for more than 2 min, labor was completed operatively and cord pH was 7.00 +/- 0.04, base excess -15 +/- -2 mmol/l and Apgar scores < or =5 at the 5th minute. In AGA fetuses, when FSPO2 was over 30%, artery pH was over 7.20, base excess <-11 mmol/l and Apgar scores > or =9 at the 5th minute; in contrast, when FSPO2 was <30% for 2 min, a cesarean section was performed and cord pH was < or =7.02, base excess > or =-13 mmol/l and Apgar scores < or =4 at the 5th minute. CONCLUSIONS: In IUGR fetuses, FSPO2 values less than 34% represent an acidotic status, while values of > or =35% are well tolerated. Fetal pulse oximetry proved reliable, according to umbilical cord blood measurements and Apgar scores, reducing cesarean deliveries in cases of nonreassuring cardiotocographic patterns in IUGR fetuses.

Acidosis↗
PubMed2003

Nasal bone hypoplasia: is it a common finding amongst chromosomally normal fetuses of southern Chinese women?

OBJECTIVE: To assess the incidence of nasal hypoplasia among fetuses of southern Chinese women. METHODS: This prospective observational study was conducted at Princess Margaret Hospital, Hong Kong. All pregnant women referred for chromosomal studies before 14 weeks were assessed. The crown-rump length, nuchal translucency thickness, and nasal bone were assessed between 11 and 14 weeks. RESULTS: A total of 143 women were recruited. In 119 fetuses, facial profiles were successfully obtained and the presence or absence of nasal bones was assessed. One hundred and fourteen fetuses had normal karyotypes. The rate of absence nasal bone when assessed between 11-14 weeks was 0.88% in the fetuses with a normal karyotype. During the same period, 2 out of 3 fetuses with Down syndrome had absence of nasal bones. A nasal bone was visualized in one fetus with Edward syndrome and the other with Turner syndrome (45 X). CONCLUSION: The incidence of nasal hypoplasia is not increased among fetuses of southern Chinese women. Assessment of ossification of the nasal bone can be used to supplement first-trimester screening in Chinese women.

Adult↗
PubMedDate not supplied

2nd-trimester maternal serum human chorionic gonadotropin and alpha-fetoprotein levels in male and female fetuses with Down syndrome.

BACKGROUND/OBJECTIVE: Several studies have shown that the 2nd-trimester maternal serum alpha-fetoprotein (AFP) level is significantly lower and that the maternal serum human chorionic gonadotropin (hCG) level is significantly higher in the presence of a female fetus. This may potentially affect Down syndrome (DS) screening such that a higher false-positive rate may occur in women carrying a female fetus, whereas a lower detection rate may result in those carrying males. The purpose of this study was to evaluate the gender impact on marker levels in DS pregnancies and its effect on DS screening. METHODS: The study included 62 DS pregnancies with a single fetus of known gender (31 male and 31 female). Only pregnancies with chromosomal analysis showing trisomy 21 were included. The maternal serum levels of hCG, AFP, and unconjugated estriol were measured at 16-20 weeks of pregnancy. These levels were expressed as gestational-age-corrected multiples of the median. RESULTS: No statistically significant differences were noted in maternal serum levels of hCG or AFP in DS pregnancies between women carrying a female and those carrying a male DS fetus. No statistically significant differences in 'screen-negative' rates were noted among male and female fetuses. CONCLUSIONS: In normal pregnancies, the maternal serum hCG level is higher, and the AFP level is lower in the presence of a female fetus. However, this gender-related difference is not apparent in DS pregnancies. Therefore, the gender-related differences in serum marker levels would not result in a lower detection rate of DS in male fetuses.

Adult↗
PubMed1989

Compensatory adrenal hypertrophy following unilateral adrenalectomy of fetuses of rats given alcohol throughout gestation.

The effect of maternal alcohol consumption on fetal compensatory adrenal hypertrophy following unilateral adrenalectomy was studied in rats. Females were given 20% alcohol in tap water for 4 weeks prior to mating and 30% alcohol in tap water throughout gestation (alcohol), or were pair-fed to the alcohol group (pair-fed) or were fed ad libitum (control). On day 20, fetuses were unilaterally left-adrenalectomized or sham operated. Mothers were sacrificed on day 22 of gestation and right adrenals of adrenalectomized, sham-operated, and unoperated fetuses were removed and weighed. Some adrenals were fixed, sectioned, and stained for histological examination. Adrenalectomized fetuses of all three dietary treatment groups demonstrated compensatory hypertrophy. Adrenals of alcohol-exposed fetuses weighed less than those of pair-fed or control fetuses, and the ratio of adrenal weight/body weight was greater, regardless of surgical procedure. Histological sections of right adrenals of left-adrenalectomized fetuses showed larger cells and widened sinusoids, compared to unoperated fetuses in the corresponding dietary treatment groups. These results are consistent with a retardation in adrenal growth and development as a result of alcohol exposure, but show that alcohol consumption throughout gestation does not affect the ability of the adrenals to undergo compensatory hypertrophy following unilateral adrenalectomy.

Adrenal Glands↗
PubMed1995

Left heart obstructive lesions and left ventricular growth in the midtrimester fetus. A longitudinal study.

BACKGROUND: Isolated case reports that suggest the potential for development of left heart hypoplasia late in gestation provide the only information about the in utero natural history of left heart obstructive lesions. METHODS AND RESULTS: We reviewed the prenatal and postnatal echocardiograms of 21 fetuses with left heart obstructive lesions, including 15 with serial antenatal study, to elucidate the antenatal natural history of this spectrum of disease and to identify features indicative of postnatal disease severity. Ventricular, atrioventricular valve, and great artery dimensions were measured and growth curves were developed with comparisons to data from 47 normal fetuses. Fetuses were divided into groups according to whether postnatally the left heart was capable (group 1, n = 10) or incapable (group 2, n = 7) of supporting the systemic circulation in the presence of a patent aortic valve. Group 3 (n = 4) included fetuses with aortic atresia. At the initial examination (21.7 +/- 3.4 weeks' gestation), left heart dimensions were normal or reduced, with the most diminutive measurements in group 3. Three fetuses in group 2 and most in group 1 had normal initial left heart dimensions. Subsequent growth of left heart structures either paralleled normal growth or was reduced, the latter resulting in the development or progression of left heart hypoplasia. All left heart dimensions grew more slowly in group 2 and group 3 than in group 1 (P < .05). Other prenatal features observed only in groups 2 and 3 included reversed (n = 10) or bidirectional (n = 1) foramen ovale flow and retrograde distal arch flow (n = 9). Initial midtrimester mitral valve and ascending aorta z scores and the growth rates of all left heart structures correlated strongly with postnatal left ventricular end-diastolic dimension (P = .0007 to .03, r = .57 to .82) and could be additional indicators of postnatal disease severity. One group 1 fetus developed severe aortic stenosis late in gestation. CONCLUSIONS: The potential for the in utero development or progression in severity of left heart obstruction and hypoplasia in left heart obstructive lesions necessitates serial prenatal study in affected fetuses carried to term.

Echocardiography↗
PubMed1980

Morphologic disturbance of lung maturation in fetuses of alloxan diabetic rabbits.

Maturation of lungs was studied morphologically in fetuses of does made diabetic with alloxan. The lungs of fetuses of does treated with alloxan 24 h after mating appeared to be less mature than control lungs, as shown by significant decrease in areal density of air space (p < 0.01) and by increases in areal density of alveolar epithelium and capillaries (p < 0.02). In alloxan fetuses, ultrastructural techniques revealed that type II cells had 10 times the control value for areal density of glycogen (p < 0.01) and 2.5 times that of rough endoplasmic reticulum (p < 0.05), but the proportion of type II cells and the number of lamellar bodies per type II cell profile were similar in both groups. Ultrastructural examination of capillaries demonstrated that their migration and the fusion of their basement membrane with that of alveolar epithelium did not occur as frequently in alloxan fetuses as in control fetuses. Biochemically, the lungs of alloxan fetuses contained significantly more glycogen and protein (p < 0.01) than control lungs, but the deoxyribonucleic acid was similar. The alloxan fetuses had a disturbance of lung structural maturation that was consistent with our previous findings of delayed functional maturation without accompanying change in disaturated phosphatidylcholine levels and ratio of lecithin to sphingomyelin.

Animals↗
PubMed1988

Sterol synthesis and low density lipoprotein clearance in vivo in the pregnant rat, placenta, and fetus. Sources for tissue cholesterol during fetal development.

Whereas the greatest relative increase in body mass occurs during the third trimester of fetal life, the source of the cholesterol that supports this growth is uncertain. These studies used [3H]water and 125I-cellobiose-labeled low density lipoproteins to quantitate absolute rates of cholesterol acquisition in vivo by the fetus of the rat. Preliminary studies demonstrated that [3H]water administered intravenously to the mother rapidly equilibrated with the body pool of water in the fetus and that 22-microgram atoms of H from the water pool were incorporated into each micromole of newly synthesized cholesterol. After administration of [3H]water to pregnant rats, the rates of sterol synthesis per 100 g of whole body weight were severalfold higher in the fetus than in the dams. Individual organs of the dam such as the liver, however, had much higher synthetic rates than those in the fetus. When maternal hepatic cholesterol synthesis was suppressed by cholesterol feeding, newly synthesized cholesterol disappeared from the maternal blood yet there was essentially no change in the rate of appearance of newly synthesized sterol in the fetus, placenta, and fetal membranes. The placenta did take up low density lipoproteins at rates equal to about one-third of that seen in the maternal liver, but none of the apolipoprotein or cholesterol was transferred to the fetus. These studies indicate that the rat fetus receives little or no cholesterol from the mother but, rather, satisfies its need for cholesterol during fetal development through local synthesis. Furthermore, the fetal membranes appear to be an important site for sterol synthesis in the fetal compartment.

Animals↗
PubMed1987

Hereditary bovine syndactyly: diagnosis in bovine fetuses.

Diagnostic guidelines were established for progeny testing of hereditary bovine syndactyly. Through the use of superovulation and embryo transfer, 139 fetuses were recovered at 50 to 77 days gestation. Normal (+/+, +/sy) and syndactylous (sy/sy) anatomy of Holstein fetuses was defined, and the accuracy of macroscopic versus microscopic limb diagnosis was assessed. Chondrification and ossification differences between normal (+/+, +/sy) and syndactylous (sy/sy) fetuses were only age-related. Normal (+/+, +/sy) fetal limbs differed from normal (+/+, +/sy) adult bovine limbs in two ways. Fetal metacarpal and metatarsal III and IV bones were not fused, and fetal metacarpal and metatarsal II and V bones often extended up to three-fourths the length of metacarpal and metatarsal III and IV bones. In syndactylous (sy/sy) fetuses, synostosis asymmetries occurred within and between fetal limbs, and between fetuses, representing variable gene expressivity. Synostosis pattern within limbs did not correspond with those of the adult bovine; the second phalangeal pair was synostotic most frequently in the fetus, followed by the first, and then the third pair. Synostosis patterns between fetal limbs agreed with those of the adult; there was a right-left and front-rear limb gradient. Partial synostoses occurred sporadically in all three paired phalanges. Those of the first and third pair always involved the tip closest to the second phalangeal pair. A unique example of variable gene expressivity occurred in one syndactylous fetus. Both front limbs were syndactylous, while both rear limbs were normal grossly. Microscopically the right rear limb was normal while the left rear limb consisted of closely apposed phalangeal blastemata without coalescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Experimental in utero inoculation of late-term swine fetuses with porcine circovirus type 2.

All 37 fetuses of 3 laparotomized pregnant sows at 86, 92, and 93 days of gestation were inoculated intramuscularly through the uterine wall with porcine circovirus type 2 (PCV-2). The sows were allowed to farrow, and blood and tissue samples were collected from their piglets before and after suckling colostrum. Thirteen fetuses from 2 sows at 90 and 103 days of gestation were used as controls. Of the 37 PCV-2 inoculated fetuses, 24 were grossly normal and 13 were mummified, stillborn, or weak-born at farrowing. Infection with PCV-2 was demonstrated in various tissues of grossly normal and abnormal fetuses by virus isolation, polymerase chain reaction, and immunohistochemical methods. Antibodies specific to PCV-2 were also detected from the sera or thoracic fluids of abnormal fetuses and unsuckled normal pigs. No evidence of PCV-2 infection was found in any control fetuses. The present results confirm previous findings that PCV-2 can infect late-term swine fetuses and may cause reproductive abnormalities.

Animals↗
PubMed1984

Excretion of vasopressin in the hypoxic lamb: comparison between fetus and newborn.

The factors associated with increased renal excretion of vasopressin (VP) were examined in the hypoxic fetus and newborn. Studies were conducted on six chronically instrumented fetal (117-136 days gestation) and seven newborn lambs (2-6-day-old). Hypoxia was produced by administration of 10% oxygen to the ewe or neonate for 30 min. This procedure caused a 50% reduction in PaO2, no significant change in pHa in either fetus or neonate and a slight fall in PaCO2. Hypoxia caused an increase in VP concentrations in plasma from 1.3 +/- 0.53 to 46.4 +/- 4.71 pg/ml in the fetus and from 5.9 +/- 2.80 to 50.2 +/- 26.68 pg/ml in the neonate. After hypoxia there was a fall in urine output from 0.27 +/- 0.045 to 0.17 +/- 0.046 ml/(min X kg) in the fetus and from 0.15 +/- 0.033 to 0.09 +/- 0.022 ml/(min X kg) in the newborn. The corresponding values for urine osmolality were the following: 168 +/- 30.8 to 325 +/- 30.6 mOsm/kg in the fetus and 388 +/- 65.4 to 523 +/- 51.8 mOsm/kg in the newborn. VP concentration in urine increased from 13 +/- 9.4 to a maximum of 176 +/- 32.4 pg/ml after 30 min of recovery in the fetus and 39 +/- 4.6 to 278 +/- 132.5 pg/ml after 1 h of recovery in the newborn. These levels remained high for at least 1 h after the end of hypoxia. There was a good linear correlation between plasma VP levels and the corresponding urine levels and excretion rates in both the fetus and newborn.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Tetralogy of Fallot, cardiac hypertrophy, pulmonary hypertension, and anomalies of great vessels in fetuses and neonates of WKY/NCrj rats.

We examined anatomically the hearts, lungs, and great vessels of 269 WKY/NCrj rats at three fetal and three neonatal stages. Severe pulmonary valve thickening was present in 16 and ventricular septal defects with overriding of the aorta in 15 of the 90 near-term fetuses and in 10 and nine, respectively, of the 79 neonates at 2-4 d of age. These abnormalities occurred together (tetralogy of Fallot) in seven of the near-term fetuses and in five of the neonates. A narrow pulmonary outflow tract was present in 55% of the fetuses and in 56% of the neonates. The wall of the pulmonary arterial branch was abnormally thick in 19% of the fetuses and in 26% of the neonates, most of which did not have septal defects. In about 80% of the fetuses, the middle latitudinal muscle bundle of the ventricular septum was not continuous with the left ventricular free wall, but rather with the right; after birth, it was discontinuous with both free walls. The heart was abnormally heavy in 49% of the 79 neonates. In about half of the heavy hearts, there were no septal defects or pulmonary valvular and arterial lesions. There were double aortic arches in four and right aortic arches in six of the total WKY fetuses and neonates; the ductus arteriosus was abnormally small in 47% and the aorta was large in 51% of the near-term fetuses. This constellation of congenital heart disease is genetic in origin, but altered by hemodynamics late in fetal life.

Animals↗
PubMed1995

Circulatory and metabolic effects of hypoxia in the hyperinsulinemic ovine fetus.

Fetuses of women whose diabetes is poorly controlled often exhibit hypoxemia and elevated catecholamine concentrations at birth. In the ovine fetus, experimental hyperinsulinemia results in hypoxemia, elevated catecholamine concentrations, and hemodynamic changes. Limited oxygen availability occurring during pregnancy-related complications and/or delivery may present an additional risk to the hyperinsulinemic fetus. In this study, we tested the hypothesis that hypoxia induced via acutely limiting oxygen availability compromises the hemodynamically and metabolically stressed but compensated hyperinsulinemic ovine fetus. Fetuses receiving insulin (n = 8) or placebo (n = 5) for 48 h were exposed to maternally induced hypoxia. Hypoxic hypoxia was associated with a surge in catecholamines in the hyperinsulinemic fetuses. During hypoxia, this group exhibited insulin-related sustained increases in the combined ventricular output and fetal body blood flow, accentuation of the prior insulin-related increase in blood flow to the heart, decreased systemic oxygen delivery, accentuation of the insulin-related increased oxygen extraction, reductions in the insulin-related increased systemic oxygen uptake, sustained increases in regional oxygen delivery to the heart and adrenal glands, reductions in the insulin-related increased delivery to the carcass, and decreased oxygen delivery to the kidneys and gastrointestinal tract. We conclude that, in the hyperinsulinemic ovine fetus, hypoxic hypoxia attenuates the hyperinsulinemia-mediated increased systemic oxygen uptake. Regional oxygen transport is preserved to vital regions (brain, heart, and adrenal glands) by increased perfusion and compromised to certain other regions (kidneys and gastrointestinal tract), because the increases in perfusion are insufficient to offset the limited oxygen availability.

Animals↗